Must I Have Personal Health Insurance In Order To Be Eligible For Workers’ Compensation?
Maybe you haven’t been on the payroll long enough to be eligible for health insurance or due to financial constraints, insurance coverage hasn’t been a priority. No matter the reasons behind why you currently don’t have health insurance, it doesn’t change the fact that you sustained an on the job injury and now your employer is refusing to file the claim through workers’ compensation.
In March 2010, the Affordable Care Act was signed into law, allowing for significant changes to our healthcare system. While the majority of these changes focus on assuring every American has the ability to obtain affordable health care, the Affordable Care Act is in no way connected with workers’ compensation coverage.
When an on the job injury has occurred, whether or not the employee is covered under any type of health insurance, should never be a factor in receiving prompt medical care and having the workers’ compensation claim filed as soon as possible. There have been cases reported where employers have tried to get out of performing due diligence and refusing to file the injured worker’s claim by stating the employee is only eligible if they are first covered under a personal healthcare policy.
Another question we hear frequently at the Dan Pruitt Law Firm concerns an employer’s responsibility when the injured worker IS covered under a healthcare policy. Again, there have been situations where an employer will erroneously tell an employee their personal healthcare policy supersedes workers’ compensation. In essence they are telling the employee they can’t or won’t file their claim because they want the employee’s healthcare insurance carrier to pay the expenses, not the workers’ compensation insurance group. Generally this is done in order to keep the employer’s insurance costs down. This can have dire consequences if the employee isn’t aware of their legal rights.
Under a workers’ compensation claim there are no out of pocket expenses as opposed to co-pays and deductibles if an injured worker’s personal healthcare policy is used. Then depending on the severity of the injury there is always a possibility of coverage caps which may limit the amount of treatment allowed. Most individual policies don’t pay travel expenses while workers’ compensation pays mileage for every medical and pharmacy visit of ten miles and over. Standard health insurance offers no payment for time off the job due to an injury, nor includes long-term permanent disability payments if your physician determines you can no longer work. These are all problems an injured employee will face if the accident isn’t filed under their employer’s workers’ compensation insurance.
Anytime you are injured on the job, no matter how insignificant you believe the injury to be, it is vital to report it to your immediate supervisor and then follow company protocol in notifying any additional departments. Remember personal health insurance is not required in order for your medical expenses to be covered under workers’ compensation. If you do have health insurance, under no condition allow this policy to be used to pay for expenses associated with your on the job injury. Often being aware of your rights is all it takes for your employer to follow the law. But if at any time, you don’t feel comfortable with the situation and just want an experienced attorney to hear your case, please don’t hesitate to reach out to the seasoned legal professionals at the Dan Pruitt Law Firm today. We are here to put your mind at ease.
Dan Pruitt is a Personal Injury Attorney who practices in Greenville, SC. He graduated from University of Georgia, and has been practicing law for 25 years. Dan Pruitt believes in fighting for the injured. Learn more about his experience by clicking here.